coRibavirin-induced Anemia in Patients with Chronic Hepatitis C Virus Infection

Anemia associated with ribavirin (RBV) and interferon therapy in patients with chronic viral hepatitis C is a hemolytic, multifactorial adverse effect, in direct correlation with the RBV dose. Additionally, the anemic syndrome is worsened by the interferon-induced bone marrow suppression of erythroid precursors. The resulting anemia is associated with low production of erythropoietin, similar to anemia seen in HIV-infected patients or in those with cancer. Our study was performed on a group of 28 patients with viral hepatitis C treated with 3 MU interferon alfa 3 times a week and RBV 1000-1200 mg/day for 12 months. A normochromic normocytic anemia was observed, requiring a reduction of the RBV dose to 600 mg/day if the hemoglobin was below 10 g/dL and interrupted if the hemoglobin level was below 8.5 g/dL. In this case, reversibility can occur within a time interval of 4-8 weeks after discontinuation of treatment.